Obstructive sleep apnea in young infants with Down Syndrome evaluated in a Down Syndrome specialty clinic

Abstract

Introduction Children with Down syndrome (DS) experience congenital and functional medical issues that predispose them to obstructive sleep apnea (OSA). Research utilizing stringent age criteria among samples of infants with DS and OSA is limited. This study examines clinical correlates of OSA among infants with DS. Materials and Methods A retrospective chart review was conducted of infants ≤6 months of age referred to a DS clinic at a tertiary children’s hospital over five-years (n=177). Chi-square tests and binary logistic regression models were utilized to analyze the data. Results Fifty-nine infants underwent polysomnography, based on clinical concerns. Of these, 95% (56/59) had studies consistent with OSA. Among infants with OSA, 71% were identified as having severe OSA (40/56). The minimum overall prevalence of OSA among the larger group of infants was 31% (56/177). Significant relationships were found between OSA and dysphagia, congenital heart disease (CHD), prematurity, gastroesophageal reflux disease (GERD), and other functional and anatomic gastrointestinal (GI) conditions. Results indicate that odds of OSA in this group are higher among infants with GI conditions in comparison to those without. Co-occurring dysphagia and CHD predicted the occurrence of OSA in 36% of cases with an overall predictive accuracy rate of 71%. Discussion Obstructive sleep apnea is relatively common in young infants with DS and often severe. Medical factors including GI conditions, dysphagia and CHD may help to identify infants who are at greater risk and may warrant evaluation. Further studies are needed to assess the impact of OSA in infants with DS.

Obstructive Sleep Apnea in Individuals with Down Syndrome: A Meta-Analytic Literature Review

“…Finally, nine studies with 629 individuals were found using an AHI cutoff ≥ 2.0, indicating an OSA prevalence of 74.2% (95% CI: 65.1 to 82.4) [3], [6], [59], [62], [65], [68], [70], [72], [77]. Thus, as would be expected, OSA prevalence decreases somewhat as more restrictive AHI cutoffs are utilized.…”

“…A cutoff AHI of ˂ 2/hr was utilized in most of these studies to define the absence of OSA, while 2.0-4.9/hr is often used to define mild OSA, 5.0-9.9 to define moderate OSA, and ˃10/hr to define severe OSA. Descriptively, across these child studies 21.5% of children had mild OSA (95% CI: 16.7 to 26.7), 20.3% moderate OSA (17.3 to 23.5), and 30.4% had severe OSA (20.5 to 41.2) [3], [6], [59], [62], [63], [65], [66], [68], [70], [76], [77]. All but two of these 11 child studies used an AHI cutoff of 2/hr for diagnosing OSA [11], [76].…”

“…Examining whether region of study origin impacted OSA prevalence, 13 studies with 1,047 participants were conducted in the United States [3]- [5], [60], [63]- [65], [69], [71]- [73], [77], [78]. The pooled OSA prevalence of these studies was 66.3% (95% CI: 53.0 to 78.4).…”

Down Sendromlu Çocuklarda Uyku Apne Sendromu Ve Ağiz Di̇ş Sağliği

“…8,13 . Bu durum DS'li çocuklarda; sağlıklı çocuklara oranla çok daha yüksek oranlarda OUAS'a rastlandığını göstermektedir.…”

Effects of Antecedent Manipulations and Social Reinforcement to Increase Lateral Positioning in a Premature Infant with Obstructive Sleep Apnea

“…However, Menon and Kumar (2013) found a supine sleeping posture is more commonly associated with obstructive sleep apnea (OSA), a common condition in infants, particularly those born prematurely. Katz, Mitchell, and D'Ambrosia (2012) indicate infants have Bboth anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities including superiorly placed larynx, increased chest wall compliance, ventilation-perfusion mismatching, and ventilatory control instability.^In addition to prematurity, OSA is increasingly common in infants born with Down syndrome (Goffinski et al, 2015), craniofacial conditions, and various other genetic syndromes (Bacher et al, 2011). Infants with OSA who sleep in supine positions have been found to suffer decreased sleep quality and efficiency such as frequently interrupted sleep due to a significant increase in the number of awakenings and obstructions (Bhat et al, 2006).…”